Synchronous breast cancer – Radiology Cases

Case contribution: Dr Radhiana Hassan

Clinical:

A 63 years old lady
Had underlying hypertension and CVA with left sided hemiparesis, ADL semi dependent walking with walking stick at home
Referred from GP
Patient noted right breast lump on SBE
Gradually increasing in size, non tender
No nipple discharge, no skin changes, no LOA, no LOW
No family history of breast cancer
Breastfed all 5 children up to 5 years
Clinically a palpable mass at right axillary tail measuring 3×3 cm, hard, attached to the skin not to the chest wall, peau de orange +ve. No nipple retraction, right axillary node palpable.
Left breast is normal, left axilla is also normal

Mammogram findings:

There is an ill-defined oval high density lesion observed in the upper outer quadrant of the right breast (yellow arrows) with associated stromal distortion and skin traction.
No clustered microcalcification seen within the lesion.
A few lobulated lesions are seen at right axillary tail region.
An ill-defined lesion with associated stromal distortion is also seen in the upper outer quadrant of the left breast. No calcification is seen within this lesion.
Skin thickening is seen at right periareolar region.
No nipple retraction bilaterally.

Ultrasound shows suspicious lesions in both breasts (images not shown)

HPE finding:

Diagnosis: Bilateral synchronous breast cancer

Discussion:

Synchronous breast cancers are two or more primary breast cancers that occur in either breast at the same time
About 1.4-12% of all breast cancers may be synchronous
Bilaterality is greatest with invasive lobular carcinoma
It is important to consider metastasis to the breast from opposite breast (which is unusual especially with no other evidence of metastasis)
It has worse survival rates because of distant metastasis

Progress of patient: